Scenario: I suspect the person I am supporting is harming himself

​The scenario

You are an employment support worker providing School Leaver Employment Support (SLES) at a local high school. Corey is a 17-year-old in Year 12. He has received additional supports regarding his learning difficulties in all subjects throughout his years at secondary school.

You have been assisting Corey each week for the past two months, to build his ability and confidence to work with a Disability Employment Service (DES) when he leaves school at the end of the year e.g. money handling, time management, travel and other employment readiness skills.

Corey is a quiet person, but he has gradually built his trust in you and has been enthusiastic about trying new things to build up his skills in readiness to work. For some weeks he was keen to show you any homework he had completed from your previous session.

Over the past two weeks he has become very negative about his homework, his friends and life in general and much less willing to participate in any activities with you. This week when he shows you his homework you notice multiple scars on his arm, some healed or partially healed, and some which appear to be recent injuries.

Tips for responding in the moment

It is inappropriate to make judgements or comments about someone’s symptoms, medications or treatments.

How you react is important:

• Don’t panic.
• Speak in a calm voice.
• Don’t judge or express a strong emotional response e.g. of anger or revulsion.
• Don’t assume Corey is suicidal because he is self-injuring.
• Don’t assume that Corey is self-injuring to seek attention. People self-injure for many reasons including to manage painful feelings and only very rarely as a means of seeking attention.
• Don’t ignore what you have seen.

What you could say:

• You could ask Corey about the scars on his arm in a way that is not confronting or challenging e.g. “Sometimes, when people are in a lot of emotional pain, they injure themselves on purpose. Is that how the scars on your arm happened?” Give Corey time to respond to this or any questions.
• Whether Corey responds or not, you could reassure him that you are there to help and want him to know he is safe and also that he does not have to talk if he doesn’t want to.
• Ask Corey what will help him to feel safe e.g. “What can I do to help?”
• Ask Corey about his self-injury, but don’t pressure him to talk. You could ask how long he has been feeling this way or self-injuring and if he has spoken to anyone about this.
• Ask if he is thinking of ending his life. Asking about suicide gives Corey a chance to talk about it.
• If Corey does respond, listen without interrupting or expressing judgement. Then reflect back what he says, summarising in your words, to show you are listening and to check that you have understood.
• If he is open to discuss, and you feel comfortable to do so, you could ask Corey about what he is using to cut himself, how he is caring for his wounds and discuss hygiene and wound care.
• If Corey has not spoken to anyone then you could ask if there is someone he trusts who he feels he could talk to e.g. his school counsellor or doctor. Encourage him to do so.
• If he is not keen, you could say, “It can be hard to talk about this and hard to stop without help. That’s why it’s important to talk to someone.” You must also let Corey know that at this school the policy requires that you tell the school counsellor if you have any concerns about a student’s welfare and wellbeing, and that you feel that this is the case here.

What approach you could take:

• Whilst this is not an emergency situation, self-injuring behaviour should be taken seriously, regardless of the severity of the injuries or the intent.
• Encourage Corey to seek professional help with learning new ways to deal with distress and negative thoughts e.g. difficulties with family or friends, school problems, depression, alcohol and drug use, grief, trauma or abuse.
• If Corey says he is thinking about suicide you need to support him to be assessed by someone who is qualified to do so, as soon as possible.
• You could offer to help organise an appointment or go with him if he would find this useful.

What you should avoid doing and saying:

• Don’t use statements that don’t take Corey’s situation seriously like, “But you’ve got a great life” or “Things aren’t that bad”.
• Don’t try to solve Corey’s problems.
• Don’t touch Corey (for example, hug or hold hands) without his permission.
• Don’t accuse Corey of attention seeking.
• Don’t make Corey feel guilty about the effect his self-injuring may be having on others.

Support escalation if needed: You can call the Mental Health Line 1800 011 511. If you feel it is an emergency situation call 000. 

Tips to help prepare for next time

• Contact your supervisor and provide the details of what occurred to obtain advice on future contact.
• Follow up with the school contact person to discuss if any further actions are required.
• Revisit the school’s student health and welfare policies that outline what you should do if you are concerned about a student’s welfare in the future.
• Learn more about self-harm online or from local health professionals.
• If you are concerned about Corey’s ongoing emotional wellbeing, check whether the school knows about local mental health services that can provide further support for Corey.
• Always follow your organisation’s policies and procedures regarding your own and client safety.
• Look after yourself. Speak with your supervisor and ask for help if the situation has left you with feelings of unease. Many organisations will have an Employee Assistance Program where you can talk to someone confidentially.

Resources

headspace, is a national organisation that provides tailored and holistic mental health support for young people aged 12 - 25 years, with a focus on early intervention. They work with young people to help get them back on track and strengthen their ability to manage their mental health in the future.
Type: Web page
Estimated reading time: multiple resources
Produced by: headspace National Youth Mental Health Foundation

Mental Health First Aid: Non-suicidal self-injury
This guideline provides more detail about self-injury, including what to say and what to avoid saying.
Type: Guidelines (PDF)
Length: 4 pages
Produced by: Mental Health First Aid